Report on Medicare Compliance 29, no. 42 (November 23, 2020)
- CMS said Nov. 16 that the Medicare fee-for-service improper payment rate dropped to 6.27% in FY 2020 from 7.25% last year, although CMS had to “modify”...more
12/1/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fee-for-Service ,
Health Care Providers ,
Healthcare Fraud ,
HIPAA Violations ,
Medical Records ,
Medicare ,
Medicare Advantage ,
OCR ,
OIG ,
Right of Access ,
Settlement
Report on Medicare Compliance 29, no. 42 (November 23, 2020) -
Medicare administrative contractors (MACs) will be coming to 911 hospitals for overpayments caused by unreported manufacturer credits for recalled or...more
Report on Medicare Compliance 29, no. 30 (August 24, 2020)
- A federal court on Aug. 17 blocked HHS from enforcing its revised definition of sex discrimination in Sec. 1557, which prohibits discrimination on the basis of...more
8/26/2020
/ Amended Rules ,
Appeals ,
Bostock v Clayton County Georgia ,
Compliance ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Gender Identity ,
Health Care Providers ,
Home Health Care ,
Hospice ,
Injunctive Relief ,
Medicare ,
Pregnancy Discrimination ,
SCOTUS ,
Section 1557 ,
Settlement ,
Sex Discrimination ,
Stays
Report on Medicare Compliance 29, no. 28 (August 3, 2020)
- The HHS Office of Inspector General (OIG) has given the green light to a plan by a charitable organization to “purchase or receive donations of unpaid medical...more
8/17/2020
/ Centers for Disease Control and Prevention (CDC) ,
Centers for Medicare & Medicaid Services (CMS) ,
Charitable Donations ,
Charitable Organizations ,
Compliance ,
Coronavirus/COVID-19 ,
Debt Forgiveness ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Medical Coding ,
Medical Debt ,
Medicare ,
OIG ,
Physician Payments ,
Public Health Emergency ,
Relief Measures
Report on Medicare Compliance 29, no. 25 (July 13, 2020)
- Ophthalmic Consultants PA in Sarasota, Florida, agreed to pay $4.8 million to settle false claims allegations that it billed Medicare and other federal payers...more
7/21/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Durable Medical Equipment ,
False Billing ,
False Claims Act (FCA) ,
Fraud ,
Guidance Update ,
Guilty Pleas ,
Health Care Providers ,
Hospitals ,
Medical Billing Codes ,
Medicare ,
OIG ,
Settlement ,
Telemedicine ,
Work Plans
Report on Medicare Compliance 29, no. 23 (June 22, 2020):
- CMS has created a new point of origin (PoO) code, G, to indicate a transfer from a designated disaster alternative care site (ACS) because of changes in connection...more
Report on Medicare Compliance 29, no. 23 (June 22, 2020):
The HHS Departmental Appeals Board (DAB) has upheld the largest stipulated penalty imposed by the HHS Office of Inspector General (OIG) in years. OIG fined...more
Report on Medicare Compliance Volume 29, no. 22 (June 15, 2020):
- The HHS Office of Inspector General has updated its Work Plan, and new items include opioid treatment challenges during the COVID-19 pandemic.
- In a...more
6/19/2020
/ Audits ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Medicare ,
OIG ,
Opioid ,
Overpayment ,
Work Plans
Report on Medicare Compliance 29, no. 21 (June 8, 2020) -
The HHS Office of Inspector General (OIG) has released its Semiannual Report to Congress, which covers Oct. 1, 2019, through March 31, 2020. During this period, OIG...more
Report on Medicare Compliance 29, no. 20 (June 1, 2020) -
The HHS Office of Inspector General (OIG) has unveiled its “OIG Strategic Plan: Oversight of COVID-19 Response and Recovery.” Its goals are protecting people, funds...more
6/2/2020
/ Civil Monetary Penalty ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Medicare ,
OIG ,
Physicians ,
Settlement
Report on Medicare Compliance 29, no. 18 (May 11, 2020)
- The HHS Office for Civil Rights has posted guidance reminding providers that “the COVID-19 public health emergency does not alter the HIPAA Privacy Rule’s existing...more
5/16/2020
/ Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Electronic Protected Health Information (ePHI) ,
False Accusations ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Hiring & Firing ,
Medicare ,
Nurses ,
OCR ,
Patient Privacy Rights ,
PHI ,
Professional Associations ,
Public Health Emergency ,
Retaliation ,
Unions ,
Workplace Safety
Report on Medicare Compliance 29, no. 16 (April 27, 2020)
- The HHS Office of Inspector General (OIG) has proposed a rule on civil monetary penalties (CMPs) for information blocking and fraud related to HHS grants, contracts...more
5/5/2020
/ Audits ,
Billing Errors ,
Civil Monetary Penalty ,
Compliance ,
Data Blocking ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Fraud ,
Kickbacks ,
Medicare ,
Medicare Billing Privileges ,
OIG ,
Physicians ,
Psychological Counseling ,
State Attorneys General ,
Telehealth
Report on Medicare Compliance 29, no. 16 (April 27, 2020) -
Because of the coronavirus, the talents of a business development executive at a hospital are wasted, and the chief financial officer (CFO) is wondering whether...more
5/2/2020
/ CARES Act ,
CFOs ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Federal Grants ,
Health Care Providers ,
Healthcare Facilities ,
Hospitals ,
Medicare ,
Provider Relief Fund ,
Public Health Emergency ,
Relief Measures ,
Risk Assessment ,
Risk Mitigation ,
Terms and Conditions
Report on Medicare Compliance 29, no. 15 (April 20, 2020)
- Maury Regional Medical Center in Tennessee has agreed to pay $1.7 million to settle false claims allegations over MS-DRG coding, the U.S. Attorney’s Office for...more
4/29/2020
/ Civil Monetary Penalty ,
Compliance ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Hospitals ,
Laboratories ,
Medicaid ,
Medical Coding ,
Medicare ,
OIG ,
Overpayment ,
Settlement Agreements ,
TRICARE ,
Unnecessary Medical Procedures ,
Work Plans
Report on Medicare Compliance 29, no. 13 (April 6, 2020)
- During the coronavirus pandemic, the HHS Office of Inspector General (OIG) is “trying to minimize the burdens on providers,” said Christi Grimm, principal deputy...more
4/20/2020
/ Compliance ,
Coronavirus/COVID-19 ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
HIPAA Privacy Rule ,
Hospitals ,
Medicare ,
OCR ,
OIG ,
Overpayment Recovery Time Limits ,
Unduly Burdensome
Report on Medicare Compliance 29, no. 7 (February 24, 2020)
- Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more
2/28/2020
/ Acute Facilities ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Elder Care ,
False Claims Act (FCA) ,
Health Care Providers ,
MACs ,
Medicare ,
OIG ,
Provider Payments ,
Recoupment ,
Settlement ,
Skilled Nursing Facility ,
Unnecessary Medical Procedures ,
Work Plans
Report on Medicare Compliance 29, no. 2 (January 20, 2020) -
- The HHS Office of Inspector General has updated its Work Plan, which includes an item on early discharges from inpatient rehabilitation facilities to home...more
1/27/2020
/ Civil Monetary Penalty ,
Compliance ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Medicare Fraud ,
OIG ,
Psychiatrists ,
Settlement ,
TRICARE ,
Whistleblowers
Report on Medicare Compliance 28, no. 44 (December 16, 2019) -
? Korunda Medical LLC, a Florida-based company that provides primary care and interventional pain management, has agreed to pay $85,000 to settle a potential...more
12/17/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Care Violations ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Necessity ,
Medicare ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Overpayment ,
Provider Payments ,
Right of Access ,
Settlement
Report on Medicare Compliance 28, no. 44 (December 16, 2019) -
One way to find out whether compliance and integrity have seeped into the bones of an organization is asking people who would know. There may be a compliance...more
12/16/2019
/ Attorney General ,
Audits ,
C-Suite Executives ,
Compliance ,
Compliance Monitoring ,
Corporate Integrity Agreement ,
Corporate Monitoring ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Executive Compensation ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Incentives ,
Medicare ,
OIG ,
Physicians ,
Stark Law
Report on Medicare Compliance Volume 28, Number 40. (November 11, 2019) -
- In a new Medicare compliance review, the HHS Office of Inspector General (OIG) said Angels Care Home Health in Salina, Kansas, didn’t comply with...more
11/15/2019
/ Change of Ownership ,
Compliance ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Home Health Care ,
Inpatient Prospective Payment System (IPPS) ,
Medical Insurance Codes ,
Medicare ,
NIST ,
OCR ,
OIG ,
ONC ,
Security Risk Assessments
California physician Donald Woo Lee was found guilty Oct. 17 for his role in providing medically unnecessary procedures to Medicare beneficiaries, upcoding, and repackaging single-use catheters for re-use, the Department of...more
10/22/2019
/ Coding ,
Consent Order ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Fraud ,
Guilty Pleas ,
Healthcare Fraud ,
Home Health Care ,
Medical Devices ,
Medicare ,
Medicare Part B ,
OIG ,
Physicians ,
Risk Controls ,
U.S. Attorney ,
Unnecessary Medical Procedures ,
Work Plans